The American journal of emergency medicine
-
Case Reports
Chemotherapy patient with Stevens-Johnson Syndrome presents to the Emergency Department: A case report.
Stevens-Johnson syndrome (SJS) is part of a continuum of severe mucocutaneous reactions, commonly thought to be triggered by certain medications. The syndrome itself is characterized by diffuse necrosis and detachment of the epidermis. ⋯ While Stevens-Johnson syndrome has been a rare toxicity, it is potentially fatal. The emergency physician should pay special attention cancer patients presenting with suspicious rashes and carefully review their medications.
-
To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis. ⋯ This investigation did not demonstrate a significant difference in ED LOS among patients with acute epistaxis treated with topical TXA or standard care. However, this data does add to existing evidence that TXA may be associated with a reduction in resource utilization, suggesting it may provide more effective bleeding control. Overall, more data is needed to confirm the potential benefits of this practice.
-
Comparative Study
Peri-intubation factors affecting emergency physician choice of paralytic agent for rapid sequence intubation of trauma patients.
No study has assessed predictors of physician choice between the succinylcholine (Succ) and rocuronium (Roc) for rapid sequence intubation (RSI) during the initial resuscitation of trauma patients in the emergency department (ED). ⋯ Roc was more frequently chosen for paralysis in the patient cluster with predominantly abnormal peri-intubation vital signs and higher rate of early ED mortality. The use of Roc was associated with hypoxemia prior to RSI and VL.
-
Refractory ventricular fibrillation occurs when there are three or more episodes of ventricular fibrillation within a 24-hour period. We report the first case of a 35-year-old woman without prior medical or family cardiac history who sustained refractory ventricular fibrillation while taking Lamictal for bipolar depression. ⋯ The patient received a Subcutaneous Implantable Cardio-Defibrillator and was discharged home. There was no identifiable cardiac or medical cause of her ventricular fibrillation and the electrophysiologist suspected Lamictal caused her refractory ventricular fibrillation.
-
New paradigm shifts in trauma resuscitation recommend that early reconstitution of whole blood ratios with massive transfusion protocols (MTP) may be associated with improved survival. We performed a preliminary study on the efficacy of MTP at an urban, Level 1 trauma center and its impact on resuscitation goals. ⋯ MTP resulted in clinically significant improvements in transfusion times and volumes. Further larger and randomized studies are warranted to validate these findings to optimize MTP protocols.